Question

Case Study, Chapter 38, Agents to Control Blood Glucose Levels

A diabetes registered nurse educator is preparing an in-service presentation for student nurses on agents to control blood glucose levels for diabetes mellitus. The in-service will include a brief review of the pathophysiology of diabetes mellitus. Drugs to be included in the presentation will include insulin, chlorpropamide (Diabinese), glyburide (Micronase), and metformin (Glucophage). (Learning Objectives 1, 4, and 5)

a.What alterations in metabolic pathways and changes to basement membranes occur with diabetes mellitus?

b.What are the key nursing implementation considerations for patients taking insulin?

c.What are the indications for chlorpropamide (Diabinese)?

d.What are the most common adverse effects of glyburide (Micronase)?

e.What are the therapeutic actions for metformin (Glucophage)?

f.What are the lifespan considerations for children who use antidiabetic agents?

Answer 1

A. What alterations in metabolic pathways and change to basement membranes occur with diabetes mellitus?

In the kidney, the microangiopathy prompts to the thickening of the glomerular capillary membrane and also to the extension of the mesangial matrix and thickening of the tubular membrane. Several mechanisms are embroiled in the pathogenesis of diabetic renal microangiopathy. These incorporate expanded synthesis of type IV collagen following hyperglycaemia-initiated change of the pattern of podocyte-integrin articulation, expression articulation of matrix metalloproteinases (MMP-2 and 3), and expanded expression of tissue inhibitor of metalloproteinase (TIMP). A modified morphology of podocytes goes with these basement membrane changes (Silverstein, Silverstein, & Nunn, 2002).

B. What are the key nursing implementation considerations for patients taking insulin?

Some of the major nursing implementation considerations for patients taking insulin include the following:

Double checking in order to prevent errors in medication

Encouraging a patients healthy way of life

Rotating the vials to mix

Rotating the injection sites when administering injections

Observe glucose levels, particularly in case of times of stress

Monitoring the food intake

Monitor for any possible infection/ or even skin hygiene

Teach the patient onself-medication

C. What are the indications for chlorpaminde (Diabinese)?

It is indicated as an aide to exercise and diet in order to improve glycemic control in those adults living with type 2 diabetes mellitus (Silverstein, Silverstein, & Nunn, 2002).

D. What are the most common adverse effects of glyburide (Micronase)?

Some of the adverseeffect of Micronase includesnausea,feeling full,heartburn,joint or muscle pain,itching or skin rash,headache,easy bleeding,blurred vision,stomach pain and low fever.

E. What are the therapeutic actions for metformin (Glucophage)?

It is an oral diabetes drug that helps in controlling the blood sugar levels in people with type 2 diabetes.

F. What is the lifespan considerations for children who use antidiabetic agents?

All children require some level of grown-up supervision in dealing with their diabetes. Weight and height ought to be measured at each visit and followed by means of suitable weight and height growth charts. An age-adjusted BMI can be computed beginning at age 2 years. Additionally, Blood pressure measurements ought to be determined effectively, utilizing the suitable size cuff and with the child relaxed and seated. Hypertension ought to be affirmed on 3 separate days separate(Silverstein, Silverstein, & Nunn, 2002).

Reference:

Silverstein, A., Silverstein, V. B., & Nunn, L. S. (2002). Diabetes. New York: Franklin Watts.